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        <p>20191104<br>地点:昆明贝瓦口腔<br>老师:云南省口腔刘波<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/01.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/02.png"><br>现状，患龋率高，充填率低(4%)<br>低龄儿童:0-6岁<br>无牙列期 6-8月<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/03.png"><br>这些，儿牙医生应烂熟。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/04.png"><br>诊疗目标<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/05.png"><br>预防管理型的儿童口腔医师<br>策略与方法<br>涉及医生，孩子，家长三者关系。<br>可以用玻璃离子做窝沟封闭。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/06.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/07.png"><br>倡导家长参与口腔保健过程，倡导牙线的使用。<br>儿童用扁线没涂蜡的。<br>三岁以前不会吐水时不一定用牙膏的。<br>第一次看牙时间，乳牙萌出时，6个月左右。<br>医生椅旁<br>氟化物使用<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/08.png"><br>混合牙列期用。<br>正畸的白垩斑可以一个月涂一次。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/09.png"><br>医用，不能家用。<br>年轻恒牙不能用高露洁涂氟，颜色问题，可能引起纠纷。<br>窝沟封闭技术<br>玻璃离子，粘接剂+窝沟封闭也可以做。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/10.png"><br>远中有牙龈时可用排龈线<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/11.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/12.png"><br>沟通问题<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/13.png"><br>预防性树脂充填<br>当窝沟卡探针的时候用。去龋，打开窝沟，用流体树脂。<br>亡羊补牢——治疗<br>儿牙医患关系:复杂。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/14.png"><br>干儿牙一定要知道放弃。<br>了解家长的类型<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/15.png"><br>民营不建议做束缚。<br>技术篇<br>治疗目的<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/16.png"><br>原则<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/17.png"><br>ART<br>手动去龋，<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/18.png"><br>无机釉还是要用手机去除<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/19.png"><br>修复方法<br>充填，嵌体，冠。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/20.png"><br>玻璃离子不能做永久充填。<br>用A1或A2色。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/21.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/22.png"><br>适应症<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/23.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/24.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/25.png"><br>操作步骤<br>1.检查咬合关系<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/26.png"><br>2.选择型号<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/27.png"><br>用蜡片来转移到口外，量。<br>3.牙体预备<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/28.png"><br>用裂钻来备引导沟<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/29.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/30.png"><br>不能有肩台。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/31.png"><br>第二乳磨牙的冠不能太大，不然会阻碍6的萌出。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/32.png"><br>修整后一定要打磨抛光。用棉花检查会不会被冠挂到。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/33.png"><br>咬合抬高不能超过1.0-1.5MM。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/34.png"><br>3M的玻璃离子水门汀<br>HELL技术，不去龋，直接粘冠。要更多证据。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/35.png"><br>决定是否做乳牙根管的考虑因素:剩余牙体、恒牙牙囊是否完好、根分叉的侧副根管(用空管糊剂放到根分叉区域)。做乳牙禁用砷剂，用多甲别放到髓底。<br>乳前牙龋修复技术<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/36.png"><br>4个型号。<br>2，3号常用。<br>操作步骤<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/37.png"><br>脱落前1.5年牙根即开始吸收，但牙不松。<br>五岁左右有生理性深覆合。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/38.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/39.png"><br>一般在舌侧戳排溢道。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/40.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/41.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/42.png"><br>气泡的问题<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/43.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/44.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/45.png"><br>厂家代表介绍<br>应用40年，有初始装，补充装。<br>成分，镍铬。<br>6也有相应产品，用作18岁以前过渡修复。<br>涂氟，涂唇侧和牙合面。<br>下午是示教和实操<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/46.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/47.png"><br>可以用纤维桩。<br>根尖2/3用vitapex根充，磷酸锌封闭，用40号纤维桩。桩进入不能超过2MM。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/48.png"><br>省口收费，400不到。<br>材料费，98颗近4000<br>根管+冠，1500左右。<br>全麻是最后的手段，无法行为管理，患牙数量多。三岁以上患儿。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/49.png"><br>最后剪手柄<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/50.png"><br>溢出沟打舌侧。<br>填树脂，切角易出现气泡，可用流体树脂。<br>就位，去除多余树脂<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/51.png"><br>光固化，拆除预成冠<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/52.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/53.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/54.png"><br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/55.png"><br>颈缘树脂没去干净。<br>后牙预成冠<br>检查咬合，选择合适的预成冠型号。<br>备牙，试戴，下颌舌侧向颊侧，上颌相反。修整牙冠。要用探针检查有无台阶，肩台。有一定要消除。<br>最难做的是下颌乳4<br>乳5远中要贴合牙体，不能阻挡6<br>后牙建议局麻下进行，可打牙周膜注射。在麻醉池中进针。颊舌侧一侧打近中，一侧打远中。<br>一般不调颌。<br><img src="https://zymblog-1258069789.cos.ap-chengdu.myqcloud.com/blog0167-child3M/56.png"></p>
<p>我发文章的三个地方，欢迎大家在朋友圈等地方分享，欢迎点“在看”。<br>我的个人博客地址：<a href="https://zwdnet.github.io/">https://zwdnet.github.io</a><br>我的CSDN博客地址：<a target="_blank" rel="noopener" href="https://blog.csdn.net/zwdnet">https://blog.csdn.net/zwdnet</a><br>我的微信个人订阅号：赵瑜敏的口腔医学学习园地</p>
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